DOI: 10.1590/2317-1782/20162015103
CoDAS 2016;28(3):311-313
Brief Communication
Comunicação Breve
ROC curve of the Pediatric Voice Related
Quality-of-Life Survey (P-VRQOL)
Curva ROC do Protocolo Qualidade de Vida
em Voz Pediátrico (QVV-P)
Lívia Lima Krohling1,2
Kely Maria Pereira de Paula1
Mara Behlau3
Keywords
ROC Curve Quality of Life Child Adolescent Questionnaires Parents
Descritores
Curva ROC Qualidade de Vida Criança Adolescente Questionários Pais
Correspondence address: Lívia Lima Krohling
Universidade Vila Velha – UVV Av. Comissário José Dantas de Melo, 21, Boa Vista, Vila Velha (ES), Brazil, CEP: 29107-372.
E-mail: livialima.r@ig.com.br
Received: April 24, 2015
Accepted: August 16, 2015
Study carried out at Universidade Federal do Espírito Santo – UFES - Vitória (ES), Brazil.
1 Universidade Federal do Espírito Santo – UFES - Vitória (ES), Brazil. 2 Universidade Vila Velha – UVV - Vila Velha (ES), Brazil.
3 Universidade Federal de São Paulo – UNIFESP - São Paulo (SP), Brazil.
Financial support: nothing to declare.
Conlict of interests: nothing to declare.
ABSTRACT
To verify the eficiency and to determine the cutoff values that discriminate children/adolescents with and without vocal complaints, as well as the measures of sensibility, speciicity and eficiency of the Brazilian Pediatric Voice-Related Quality-of-Life Survey (P-VRQOL). The participants included 230 parents of children/adolescents of both genders, aged between 2 years and 18 years, with and without vocal complaints that responded the validated Brazilian version of P-VRQOL. The three scores (total, physical and social-emotional) were analyzed by the Receiver Operating Characteristic Curve (ROC curve). The cutoff values, ROC curve and the measures of speciicity, sensibility and eficiency varied as the score investigated - total, physical or social-emotional. The total score demonstrated excellent discrimination (eficiency=0.936; speciicity=0.991; and sensibility=0.881); the social-emotional score was a reasonable indicator (eficiency=0.794; speciicity=0.604; and sensibility=0.983) and the physical score was an excellent sorter (eficiency=0.918; speciicity=0.946; and sensibility=0.890). The cutoff values and area under curve were: total score- cutoff=96.25 and AUC=0.98; physical score- cutoff=91.68 and AUC=0.97; social-emotional score cutoff=96.87 and AUC=0.79. The P-VRQOL is an excellent sorter to discriminate children/adolescents with and without vocal complaints. The perception of parents about the presence of vocal problem allows the judge of lower quality of life in 98% of the cases, especially, in P-VRQOL physical domain.
RESUMO
CoDAS 2016;28(3):311-313
Krohling LL, Paula KMP, Behlau M 312
INTRODUCTION
The parental assessment protocols have been highly recommended in the pediatric voice clinic, since the young age of the patient can derail the vocal self-assessment(1). Among the parental assessment procedures, we highlight the quality
of life related to voice, enabling better targeting of therapeutic procedures(2-4).
The Pediatric Voice-Related Quality-of-Life protocol
(PVRQOL) with Brazilian validation(3) allow the parents to measure the impact of a voice problem in their children quality
of life(4) in a sensitive and reliable manner; it has 10 afirmative questions (4 from socioemotional ield of quality of life and 6 from the physical sphere) with application between 2 and 18 years
old(5). Regarding the psychometric measures of the PVRQOL
validity(3) and considering the increasingly frequent use, we
aimed to determine the cutoff points of the instrument and
sensitivity, speciicity and eficiency measures.
METHODS
Approved by the Ethics Committee (027/11). The study included 230 parents of children/adolescents with and without voice complaints, from both genders, aged between 2 and 18;
all of them signed the informed consent form. The collection occurred in speech therapy clinic-school, private and public schools and otolaryngology clinics. The clinical characteristics of the participants are listed in Table 1.
The PVRQOL scores were analyzed by the Receiver Operating Characteristic (ROC curve) that allowed for the determination of
the cutoff value by the combination of the greater speciicity and sensitivity, veriication of eficiency, sensitivity and speciicity, allowing the classiication of children and adolescents with and without voice complaints by the deinition of the area under the
curve (area under curve – AUC).
The ROC curve is a binary tool with ive degrees of rating:
Excellent (0.9 to 1), good (0.8 to 0.9), fair (0.7 to 0.8), poor (0.6 to 0.7), and not discriminating (0.5 to 0.6)(6). Sensitivity
data translated the number of true positives identiied by the PVRQOL, compared to all positive who completed the instrument. The speciicity data relect cases false positive
compared to all negative.
RESULTS
The groups with and without voice alteration complaints were similar regarding gender (p = 0.231) and age (p = 0.874). The cutoff
values, AUC, sensitivity and effectiveness varied according to
the investigated score. The overall score showed cutoff values of 96.25, excellent area under the curve, excellent speciicity, high sensitivity, and excellent eficiency. The social-emotional
domain had cutoff value of 96.87, reasonable AUC, excellent
sensitivity, poor speciicity and reasonable eficiency. And the
physical domain obtained cutoff value of 91.68 and excellent
area under the curve, with good sensitivity, excellent speciicity and eficiency - see Table 2.
DISCUSSION
Data from the ROC curve of the overall score showed that parents/guardians, when recognizing their child voice problem also realize the impact on quality of life in 98% of
cases. Moreover, it can be stated that the PVRQOL separates
individuals with and without vocal complaints, even without the diagnosis of dysphonia; what sets it as an excellent tool for
screening, evaluation and vocal accompaniment.
The excellent speciicity showed that PVRQOL only points loss in quality of life regarding the problem of vocal complaint; and the good sensitivity indicated that individuals with a complaint may not be detected, which reinforces the importance of crossing
the self-assessment, clinical and laryngeal assessment for the
correct diagnosis of dysphonia. As the excellent eficiency ensures that the PVRQOL faithfully measures what it proposes, it is a
tool of easy administration and short application(5).
The parents/guardians recognition of 2 of the 10 questions
of the protocol there is a problem, even if small (value of 2 in
Table 2. Cutoff value, Area under the curve, Sensitivity, Specificity and Efficacy of the PVRQOL protocol
Cutoff value Are under the curve Sensitivity Specificity Efficacy
General score 96.25 0.988 0.881 0.991 0.936
Socioemotional score 96.87 0.797 0.983 0.604 0.794
Physical score 91.68 0.971 0.890 0.946 0.918
Caption: Analysis by ROC curve
Table 1. Characterization of children/adolescents with and without voice complaint
Group Female Male P-value
M x F Total Average age
P-value Age
Average score
Minimum score
Maximum
score Median
Group with voice complaint
50 62
0.231
112 9.9
0.874
G=78.65 SE=85.37 P=73.78
22.5 97.5 100
Group without voice
complaint
62 56 118 9.8
G=99.05 SE=99.89 P=98.47
90 100 100
CoDAS 2016;28(3):311-313
ROC curve of P-VRQOL 313
the likert scale of PVRQOL), indicates a possible change in the
child/adolescent voice, since the overall score will be below the cutoff grade; which reinforces the fact that PVRQOL is a central goal protocol voice with excellent speciicity and eficiency.
The speciic analysis of the PVRQOL domains concludes that the socioemotional domain was not enough to differentiate the individuals, as the AUC was reasonable, demonstrating that
it is not a strong parameter for the detection of voice changes. In addition, the excellent sensitivity accompanied by poor
speciicity and relative eficiency showed that, although it is sensitive to voice complaint is not speciic to a voice change.
The physical domain, in turn, showed better data with excellent AUC, good sensitivity and good speciicity and eficiency. Thus, however the children/adolescents with vocal complaints are not always identiied by this domain, it only recognizes impairment in quality of life before a vocal problem; it is therefore the most speciic and robust domain of PVRQOL.
The three protocol scores can be taken into consideration.
However, it is recommended attention to the characteristics identiied above; it is necessary to analyze, irst, the results of the overall score, followed by physical and socioemotional
scores. For vocal screening actions, it is recommended, initially, the use of the overall score for criterion of approval or failure,
since it has excellent speciicity and eficiency.
CONCLUSION
The PVRQOL is an eficient and reliable parental assessment tool with excellent discriminatory power, which can be used
in the screening revaluation actions, even if the individual has
not been diagnosed with dysphonia. The parents’ perception
about the presence of a change in the child’s voice allows our understanding of loss of quality of life in 98% of cases, especially
from the physical aspects perspective.
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Author contributions
